intrapartum 2 Flashcards
admission
greet and raport, orient, informed consent, notify hcp/cnm
admission assessment
in labor? term or preterm
rf?: htn, bleed, DOPE (diabetic, obese, previous large, excessive weight gain)
ambulation or bed rest
freq of monitoring - continuous, intermittent
birth plan (env, pain mng, emergency, newborn care)
support
admission PA
all regular
ob hx: GTPAL, any problems present or past, fetal acitvities
labs = blood type, Rh, cbc, type and screen
GBS: + = start abx (PCN or clindamycin)
rubella (immune, non, equivocal)
urine (protein)
EFM
toco on fundus, US = where fetal shoulders are (loudest HB)
FSE
firm part, avoid sutures and fontanelle
not affected by moms movement
advantages: clearer tracings, provide better info about variability, nurse can place
disadvantages: infection, injury, requires ROM and sufficient dilation
EFM - US
advantages: continuous graphic recording, baseline, variability, changes in FHR, noninvasive, no rupture of membranes, nurse can place
disadvantages: interference from maternal and fetal movement, weak signal, tracing may become sketchy and difficult to interpret
EFM - toco
advantages: noninvasive, easy to place, may be used before and after ROM, can be used intermittently, permanent continuous recording, nurse can place and palpate contractions for intensity
disadvantages: must compare subjective findings with monitor, bel may become uncomfortable and require freq readjustment, mother may feel limited to move, dose not provide intensity
IUPC
when toco insufficient
intensity! want MVU sum >200 and <300 in 10 min, c <2min, <5 c in 10 min want q2-3min, resting tone should be <25mmHg
advantages: intensity, allow accurate timing of contractions, permanent record of uterine activity
disadvantages: must have ROM and adequate dilation, invasive, increase risk of infection or uterine perforation, CI with active infection, use with low lying placental can result in placenta puncture, OB or midwife place
labor status assessment
membranes intact or ruptured (SROM or AROM) - time, color (clearn, bloody, meconium), amount, odor (COAT)
c: freq, duration, intensity
vaginal exam: bimanual, 2 fingers; cervix: post, mid, ant; dilation, effacement; fetal presentation and station
fetal position: US, leopold’s maneuver
membrane status: nitrazine tape
- = yellow, urine?
+ = deep blue, alkaline amniotic fluid
membrane status: ferning test
crystalized formation
+ = ferning in amniotic fluid slide under microscope
membrane status: amnisure
swab of discharge -> solvent (1min) -> test strip (5min) -> results (<15 min)
+ = 2 lines
- = 1 line
invalid = o lines
fetal position: leopolds maneuver
help determine where to put US
1st: head (hard) or butt (soft) at fundus
2nd: arms (bumpy) or back (smooth) side of abd
3rd: presenting part at symphysis pubis, hard = head, hard to feel or soft = butt
4th: outline with palms, higher head = feel more
fetal status
baseline FHR (110-160) at least 10 min
change in FHR: accel (</>32 wk), decel (early, late, variable, prolonged, sinusoidal)
periodic = with contraction, episodic = no contraction
variability (absent, minimal, mod, marked), fetal brady (<110 for 10 min, bleeding)), fetal tachy (>160 for 10 min, temp!, med, infection) -> fetal O2
decels
VEAL CHOP
early = head compression
late = uteroplacental insuff (low bp leads to low perfusion)
variable = cord compression, abrupt (umbilical cord prolapse)
prolonged = > 2 min but <10 min, decrease greater than 10 from baseline
sinusoidal = perfect wave, acidosis, deliver
variability
absent = undetectable
minimal = <5, sleep, pain med, mgso4
mod = 6-26, good!
marked = >25
non reassuring FHR patterns
variable decel (persistent and severe), late decel, prolonged decel, no variability, sinusoidal, severe brady or prolonged tachy
category 1
normal
110-160, mod, no late or variable decel
category 2
indeterminate
minimal or marked, no accel, prolonged decl, recurrent variables or late decels with moderate variability
category 3
abn -> deliver
sinusoidal, absent, recurrent lates, variables, or brady
FHR nc
UNCOIL
change position -> L side
oxytocin with late or prolonged -> turn off
increase IVF
o2 (10L/tight non rebreathing face mask)
notify MD/midwife
toco if contracting to decrease uterine activity (terbutaline)
prep for delivery if uncorrectable (vaginal near = forceps or vacuum, vaginal remote = c/s
stage 1: latent nc
anticipatory guidance, infor and support, encourage ambulation, ice chips/fluid, VS q1, temp q4 or q2 if ROm, FHR q30-60 (risk and normality)
stage 1: active nc
palpate q15-30 or continuous, vaginal exams, void q1-2, start IV fluid infusion, auscultate FHR q15-30, VS q15-30, color, odor, amount + FHR when ruptured; change position and pads often
stage 1: transition nc
palpate q15 or continuous, vaginal exams, FHR q15-30, assess q15-30, assits with breathing, keep from pushing until fully dilated, peanut ball (epidural, rotation OP->OA)
